Validation of the “fitness criteria” for the treatment of older patients with acute myeloid leukemia: A multicenter study on a series of 699 patients by the Network Rete Ematologica Lombarda (REL)

Erika Borlenghi, Chiara Pagani, Patrizia Zappasodi, Massimo Bernardi, Claudia Basilico, Roberto Cairoli, Nicola Fracchiolla, Elisabetta Todisco, Mauro Turrini, Chiara Cattaneo, Matteo Da Vià, Fabio Ciceri, Francesco Passamonti, Valentina Mancini, Mariarita Sciumè, Elisa Cerqui, Margherita Sciumè, Giuseppe Rossi

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Treatment of older patients with acute myeloid leukemia (AML) is still controversial. To facilitate treatment decisions, the “fitness criteria” proposed by Ferrara et al. (Leukemia, 2013), including age > 75 years, performance status and comorbidities, were verified retrospectively in 699 patients with AML (419 de-novo, 280 secondary AML), diagnosed at 8 Hematological Centers (REL). Methods: Patients were categorized in FIT to intensive chemotherapy (i-T) (292, 42.5%), UNFIT to i-T (289, 42.1%), or unfit even to non-intensive therapy (non i-T) (FRAIL) (105, 15.3%). Biological characteristics and treatment actually received by patients [i-T, 274 patients (39.2%); non i-T, 134 (19.2%), best-supportive care (BSC), 291 (41.6%)] were recorded. Results: “Fitness criteria” were easily applicable in 98.1% of patients. Overall concordance between “fitness criteria” and treatment actually received by patients was high (79.4%), 76% in FIT, 82.7% in UNFIT and 80% in FRAIL patients. Fitness independently predicted survival (median survival: 10.9, 4.2 and 1.8 months in FIT, UNFIT and FRAIL patients, respectively; p = 0.000), as confirmed also by multivariate analysis. In FRAIL patients, survival with any treatment was no better than with BSC, in UNFIT non i-T was as effective as i-T and better than BSC, and in FIT patients i-T was better than non i-T or BSC. In addition, a non-adverse risk AML, an ECOG PS <2, and receiving any treatment other than BSC had a favorable effect on survival (p < 0.001). Conclusion: These simple “fitness criteria” applied at the time of diagnosis could facilitate, together with AML biologic risk evaluation, the choice of the most appropriate treatment intensity in older AML patients.

Original languageEnglish
Pages (from-to)550-556
Number of pages7
JournalJournal of Geriatric Oncology
Volume12
Issue number4
DOIs
Publication statusPublished - May 2021

Keywords

  • Acute myeloid leukemia
  • Fitness
  • Karyotype
  • Older
  • Treatment

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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